MID- AND LONG-TERM OUTCOME OF TOTAL KNEE ARTHROPLASTY FOR ADULT JUVENILE IDIOPATHIC ARTHRITIS PATIENTS

Abstract

The purpose of this study was to evaluate the mid- and long-term outcomes of total knee arthroplasty in adult patients who have advanced juvenile idiopathic arthritis (JIA).

Between 1989 and 2001, twenty-two knees of JIA adult patients were treated with primary arthroplasty. Surgical challenges included fixed valgus and flexion deformity. All patients were evaluated (mean 8.0 years) using established and new scoring systems.

Knee arthroplasty provided relief of pain and stiffness and moderate improvement in range of motion in this severely affected patients. Although outcomes were scored poorly on established instruments, patients rated their benefits of the operation highly.

To evaluate the mid- and long-term outcomes of total knee arthroplasty in adult patients who have advanced juvenile idiopathic arthritis (JIA).

Between 1989 and 2001, twenty-two knees in fourteen adult patients with severe JIA were treated with primary arthroplasty. Surgical challenges included relative condylar and patellar overgrowth within a contracted, inelastic soft tissue envelope, osteoporosis, small sized bones and fixed valgus and flexion deformity including ankylosis. All patients were evaluated (follow-up: mean 8.0 years) using established and new scoring systems (postoperatively at follow-up and preoperatively by recall)..

Patients’ postoperative pain and stiffness VAS were significantly less than preoperative scores, with mean changes of 8.8 and 7.2, respectively. A mean post-operative flexion arc of 77° (range 30°–130°) was observed. All lower limbs were post-operatively aligned between 0° and 5° of mechanical valgus. Incomplete radiolucent lines were present in 27% of knees, but were not associated with clinical symptoms. Final SF-36, EQ-5D and WOMAC scores were relatively low, but 82% of patients rated themselves satisfied with the functional outcome, 100% with pain relief, and 100% stated that the outcome met or exceeded their expectations. Issues deemed by JIA patients to be important were identified by the patient specific questionnaire (PASI-pg), but not by SF-36, EQ-5D or WOMAC.

Knee arthroplasty provided relief of pain and stiffness and moderate improvement in range of motion in this severely affected adult JIA patients. Although outcomes were scored poorly on established instruments, patients rated their satisfaction with and benefits of the operation highly.

Funding:

B. Jolles received a Ligue Vaudoise contre le Rhumatisme Award for her work on Rheumatoid Arthritis.